Individual
CHALISE PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
65 N 1150 W, HURRICANE, UT 84737-2062
(435) 879-7677
Mailing address
5500 MING AVE STE 410, BAKERSFIELD, CA 93309-4631
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
14208038-4003
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14208038-4003
LICENSE
UT
Enumeration date
03/21/2025
Last updated
03/21/2025
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